Risk

Risk is the possibility of danger, harm or abuse occurring. This risk may come from a person's behaviour or from a physical situation. It is the chance that somebody could be harmed, together with an indication of how serious the harm could be.

Examples of risks in support work include:

• The possibility of slipping on spilt liquid and falling.
• The risk of overdose from inappropriately accessed medication.
• The possibility of being attacked by an unpredictable or aggressive client.
• The risk of injury when lifting a client.
• The possibility of mental distress due to workplace bullying, stress or fatigue.

Hazards

A hazard is something that could potentially lead to injury or harm, such as a broken step or a bottle of bleach. This is different from the risk, which is the probability of harm occurring due to the hazard.

Watch: Hazard vs Risk – Same Difference? (1:31 Minutes)

Watch the following video explaining the difference between hazards and risks. After watching the video, write a list of hazards which you could find in a healthcare environment.

Activity

Click on the arrow button to work through the following slides, describing hazards found in the healthcare environment.

Identifying hazards in the workplace

Some hazards are obvious and easily identifiable, but others might not be identified until they manifest as a risk. The following are examples of ways you could proactively identify hazards in your workplace.

• Conduct a thorough safety inspection check.
• Consult with colleagues to see if they have identified anything dangerous.
• Check any organisational policies and procedures.
• Observe the behaviour of those you support and identify any habits or actions that could potentially lead to harm.
• Talk to your client; they may have identified hazards in their home.

Assessing risks

A risk assessment is an examination of an environment, any items within it and anyone or anything (including the person’s own behaviour) that could cause harm or lead to the abuse of individuals. The purpose of this examination is to assess whether certain precautions are needed in order to manage any identified risks. You will need to think about the environment, identify any hazards and decide if they are actual and/or potential risks.

Risks must be assessed so that you can identify the effect or consequence of the risk. You need to consider what risk is posed, who could be affected by the risk, and what the circumstances of the risk are. The following are risk categories based on the effect (consequence) of the risk.

Organisations usually choose to focus attention on moderate and high-risk areas within the organisation.

Organisations may use other ways to describe the effect or impact of risk. This could include a numbering system from 1-10 or a financial scale measured in monetary terms or costs. The organisation you are employed by will have a way of describing the level of risk for each risk it has identified.

Risk assessment matrix

A risk assessment matrix is an example of a tool that can be used to help assess risk in your workplace.

The risk assessment considers both the likelihood of a risk occurring (from rare to very almost certain to happen) and the severity of the consequences if the risk occurs (from insignificant to major). Based on these two pieces of data, a level of risk is calculated, ranging from very low to critical.

The speed with which the risk needs to be addressed is determined by the level of risk. A critical risk must be dealt with immediately. A very low risk does not need to be addressed (but should be monitored in case the risk level changes).

Activity

Think about the level of risk you would apply to the following:

• The risk of a person entering a residential care facility and physically attacking a resident.
• The risk of a person with an obvious respiratory illness refusing to wear a mask when visiting an elderly relative.
• The risk of your client yelling at you when they become frustrated.

Types of risks

The following are some categories of risks that may be identified during a risk assessment.

General health and safety risks

When hazards are not managed, accidents may occur. This could result in injury to the healthcare worker or their client. A ‘near miss' is an incident that could have caused an accident. Not having an active health and safety programme within an organisation could be seen as a risk. 

Legal risks

If an organisation acts in a potentially illegal manner, they may be subject to civil or criminal prosecution. Examples may include being accused of breaking privacy law or providing treatment to a client without informed consent. Dissatisfaction from a client or their whānau may lead to complaints, and the way these complaints are managed and followed up can present a legal risk.

Emergencies

Civil defence emergencies such as fires or earthquakes are risks. A major fire in a residential facility would have the potential to cause injury and death. Even a minor fire, such as in a kitchen, would potentially impact the service that could be delivered to residents.

Governance

A poorly managed or governed organisation presents risks. Poor financial management may result in insufficient funds, leading to a less effective service. Unsafe systems, lack of training or supervision, lack of information, along with poor work culture are all potential risk factors. A poorly governed organisation risks losing contracts to provide services.

Clinical risks

Infection control, for example, outbreaks of infection or the inadequate sterilisation of medical equipment, presents a risk. Errors in the management of medication are a major area of risk in healthcare. Staff working outside their scope of professional practice is also a risk if they attempt to provide medical treatment they are not trained to perform. Abuse or neglect of clients would potentially pose both a clinical and legal risk.

Environmental

Environmental risk includes factors such as the weather, for example, very cold or hot temperatures or storms. The layout and maintenance of buildings may present risks, for example, inadequate lighting, poor ventilation or obstructed or difficult access to emergency exits. Outside terrain, such as steps or hills and other factors, such as a busy road nearby, may also present risks.

Activity

Read the following article: Home care support workers burnt out and unable to take breaks.

Overworking support workers can have several potential risks and negative consequences, both for the workers themselves and for the organisations or individuals who rely on their services. Reflect on what some of these potential risks could be.

Click on the heading to display information on potential risks.

Context of risk

The nature of care and the context of risk can differ from place to place and organisation to organisation.

Residential environment

Residential care situations include facilities designed for the older person, community homes with supervision, residential rehabilitation centres, secured units, and hospital-level care. In some organisations, the work environment may be controlled from within the work setting. For example, the supervisor or manager is on site. In other work environments, workers may work in isolation or on shifts in community homes, and they are supervised from a distance, such as from a central office.

Home-based environment

Workers who provide support to a person in the person’s home face hazards similar to those experienced in other healthcare settings. However, the home-based work environment is likely to be less controllable. It can be isolated as support workers often work alone. Supervision may be from a distance, and there may be delays in response to calls for assistance owing to the distance or degree of isolation. They may be more likely to perform potentially hazardous activities such as lifting people or shifting medical equipment alone.

The home-based working environment restricts the employer’s ability to control the place of work. It could be in a state of disrepair, conditions may be unhygienic, or there may be hazards such as faulty appliances, electrical wiring, or breakages.

People also have a greater degree of autonomy (personal control) in their own homes, which support workers must respect. Support workers may be more likely to make allowances for people’s behaviour and can gradually come to accept increasingly dangerous behaviours as ‘normal’ or manageable.

Community facilities

Community facilities such as pools and community centres present risks that cannot always be planned for. As a support worker, if you are using community facilities and services, it is important to follow any risk management plans in place for your client. It is also important to think about some of the risks that you may encounter and have strategies in place that will help to keep the person safe.

Excursions

Excursions or trips pose their own unique risks. If you are planning or participating in an excursion, always make sure you visit the place yourself first before you take any person or group there. You need to be able to identify any possible risks and how you will deal with them before actually making the trip.

The Health and Safety at Work Act requires all significant hazards to be identified, eliminated, or controlled by substituting, isolating or minimising them.

The hierarchy of controls

The hierarchy of control is a tool used to help you to work through safety problems and reduce the risk.

Eliminating the risk (level one)

Eliminating the risk is the highest level in the hierarchy. Removing a risk completely is always the preferred option when available as it means there is zero chance of a future incident occurring. While it may not be possible to remove the risk completely in most cases, it should always be the first control measure explored. An example of risk elimination could be providing extending poles operated from the ground to access a high window latch rather than requiring climbing a ladder, which presents a risk of falling.

Substituting the risk (level two)

The next level down in the hierarchy is risk substitution. Risk substitution is the process of removing risk by replacing it with another risk that is either less likely to occur or less severe in its potential damages. Substitution is less preferred to eliminate the risk completely as it still leaves a risk present, albeit in a reduced form. An example of risk substitution could be to replace noisy equipment with a quieter option, or it could be replacing a highly toxic chemical with a less dangerous version. It’s important to conduct a new risk assessment after the substitution has been completed to identify any new risks created by the substitute process.

Isolate the risk (level three)

The third level in the hierarchy is risk isolation. Risk isolation is performed by placing some form of barrier between the employee and the risk factor in order to provide protection. The key difference between this level and risk elimination (level one) is that the risk is still present, with the employee only shielded from it by the barrier. If the barrier were to fail or require bypass, the risk would return to being uncontrolled. Risk isolation could be enacted by placing dangerous machinery in a separate room from the operating and installing remote control systems.

Engineering controls (level four)

Engineering risk control is the process of designing and installing additional safety features to workplace equipment. Safety features could be installing more stringent ventilation systems in noxious environments or installing guardrails on a raised walkway.

Administrative controls (level five)

Level five of the hierarchy is administrative controls. These are measures the management and chain-of-command can implement to reduce the likelihood of a risk occurring. Measures could include providing dedicated training targeted at the risk or arranging work schedules to limit exposure times in hazardous environments.

Personal protective equipment (level six)

The final level in the hierarchy of risk control is the use of personal protective equipment (PPE). It’s likely that this level will be utilised regardless of what other levels are also being used to control risk. However, it remains at the bottom of the hierarchy as it doesn’t remove or reduce the risk itself. Instead, this level is designed around assuming an incident will occur and protecting the employee from harm when it does. Personal protective equipment includes hard hats, noise-reducing ear protection, or cut-resistant gloves.

Risk management is the process of assessing risk and developing strategies to manage those risks.

Managing risk requires a proactive approach, following a series of steps to devise a management plan and continuously communicating about the risks to everyone involved.

Levels of risk management

Risk management can be applied at different levels:

• Strategic or management level: for example, the management team or board would consider organisational risks.
• Operational level: for example, clinical services.
• Project level: for example, when a new project or service is started.
• Specific risk level: for example, where risk has already been recognised for infection control.

The risk management process

The Health and Safety in Work Act states there is an expectation that there will be regular reviews of your work activities to identify, assess and control risks. Everyone is responsible for making sure this happens. A risk management process is the way in which risks are considered and managed.

Plan - identify and assess risks

Do - eliminate or minimise risks

Check - monitor the control measures

Act - review for continuous improvement

Activity

View the following cards to learn about the steps in the risk management process.

A risk management plan sets out how any identified risks can and should be managed. The risk management plan must be regularly reviewed in accordance with organisational and legal requirements. You will need to know the risk management plan well and how to implement the plan of the tangata you support. It may include risks that you have little or no control over. It may be something that you can directly influence, for example, managing an infection or practising good hygiene.

The key steps to a risk management plan

1. The situation should be identified.
2. The situation should be investigated by:
   • those with the skills and knowledge to assess the situation
   • a multidisciplinary team who can make a more informed or holistic assessment
   • the person with an overview of the project
3. All the facts should be gathered so that the risks can be identified. These include the risks for service users, the support worker and others.
4. The risk should be categorised, for example, high, medium, or low.
5. Actions should be decided on, including:
   • what needs to be done to prevent harm from occurring, for example, hazard identification forms
   • allocating responsibility and resources such as training
   • allocating realistic timeframes
6. A strategy for follow-up and review needs to be planned. It should include points such as the following:
   • This information needs to be communicated to everybody.
   • Checks need to be made to make sure the actions have been taken as planned.
   • Review checks need to be made to see whether the actions and plan have been effective.

Evaluating and amending risk management plans 

If a person you are supporting has a risk management plan, it is important to evaluate the effectiveness of that plan. Health and wellbeing organisations will have their own way of monitoring risk, reviewing risk, and updating the risk management plans to keep them current and effective.

If, in your daily work, you observe new hazards or risks, it is important that you make a note of them. Your colleagues may also have made observations and discussed these with you. These issues then need to be reported using the organisation's procedures. This may be an informal process, such as emailing your supervisor, or there may be a more formal process, such as submitting a report at a team meeting. Larger organisations may have a risk committee, and senior management will review reports on risk and quality.  

Remember to get feedback from the client. They will have their own viewpoint on the effectiveness of the plan and how it has impacted the quality of their life. Customer satisfaction surveys will also provide feedback.

From all of the above, the effectiveness of the plan will be evaluated. Recommendations may be made for change or improvement, or indeed for no change, retaining the status quo. There needs to be a rationale for recommendations for change.

When evaluating a plan, consider:

• Is the plan practical to implement?
• Is the outcome of the plan what was intended? If not, why not?
• Does the plan have the desired effect? If not, why not?
• What would be an improvement that could be made? How would this improve the plan?

Remember: A risk management plan can never be perfect, but evaluating the plan and constantly refining it will improve the process of risk management. As all potential risks are analysed or checked, the outcome or impact is considered for each risk.

Control measures

The type of control measure implemented will depend on the hazard type. Some examples include:

• Placing warning signs for a slip hazard.
• Training staff on the safe use of new equipment.
• Locking doors and windows to maintain security
• Ensuring there are enough suitably qualified or experienced staff on every shift.
• Ensuring sufficient personal protective equipment is made available.

The context will determine the type of control measures that can be taken. For example, a trip-hazard sign may work in a residential care location but be totally inappropriate in the home-based environment.

Hazard signs and symbols

Safety signs are used to alert people to potential hazards, show the location of emergency and safety equipment or give instructions for dealing with emergency situations. Symbols and graphics save time in emergency situations. They can easily be identified and interpreted by people who are unable to read or understand a written language.

Here is a chart of safety signs and symbols that are commonly used in most settings:

Poison

Emergency exit

Fire equipment

First Aid equipment

PPE must be worn

Cytotoxic drugs

Biological hazard

Sharps disposal

Radiation

An organisation’s needs will determine whether its control measures limit or restrict the risk from occurring or prevent it from becoming worse. If the controls implemented are insufficient to make the risk level acceptable, then the organisation needs to determine what else is required and plan to implement new controls.

It is impossible to list every possible risk and control measure for every possible situation. Common sense tells you what might go wrong, and common sense also tells you what to do to protect yourself and others. If in doubt, ask your supervisor.

Risk management plans will never be perfect. They need to be updated to make sure that the current methods are still working and are relevant. It is only worth spending time and money in managing risks that are considered likely to occur.

Consolidation activity

In the following activity, you have been presented with two risky scenarios for an in-home care setting. For each, you will analyse the risk and suggest potential solutions, drawing on your knowledge of the risk assessment matrix and the implementation of controls.

Risk management strategies are used to minimise all risks. When supporting the implementation of a person’s risk management plan you are minimising the identified risk situations and supporting the person to be safe.

Some strategies you may be involved in are:

• Using your common sense and being practical in the support you offer
• Ensuring the support you give is practical and fair
• Reacting early enough to prevent a risky situation
• Ensuring that you provide opportunities for the person to explore and experience their environment safely.

A support worker may be involved in identifying early warning signs, and these should be documented in the individual risk management plan and reported, recorded and acted upon.

A support worker may also contribute to managing risk through being involved in a multidisciplinary team. For example, attending meetings and providing feedback or reports on individual people.

Consider some of the strategies used to manage risk below.

Overall, having a strategy when managing risks is crucial for organisations to achieve their objectives, protect their assets, and maintain confidence in those involved. A well-planned and implemented risk management strategy can help organisations to thrive in a complex and uncertain environment.

Reflection

For each of the following situations, identify the risk and a strategy or strategies for managing the risk.

1. Taking a service user to a dental appointment.
2. Observing a service user pushing his father roughly.
3. Coming into contact with the blood of a service user who has hepatitis. 
4. Seeing a senior staff member bullying a new support worker.

Workplace policies and procedures to address risk

Workplace policies and procedures to address risk are guidelines and protocols established by organisations to identify, assess, and manage potential risks in the workplace. These policies and procedures are designed to protect employees, clients, visitors, and the organisation itself from harm or damage and to ensure compliance with legal and regulatory requirements.

Overall, workplace policies and procedures to address risk are essential for maintaining a safe, healthy, and productive workplace and for minimising the potential negative impact of risk on employees, clients, and the organisation itself.

There are four common models of policies and procedures that workplaces use to address risk.

Health and safety policies

These policies outline the organisation's commitment to providing a safe and healthy work environment and describe the procedures for identifying and addressing potential hazards, such as providing personal protective equipment (PPE), conducting risk assessments, and reporting incidents and accidents.

Emergency response procedures

These procedures provide guidance on how to respond to emergency situations, such as fires, natural disasters, or medical emergencies. They outline the roles and responsibilities of employees, provide evacuation routes and emergency contacts, and describe how to communicate with emergency services and stakeholders.

Information security policies

These policies outline the procedures for safeguarding sensitive information, such as personal or medical data. They describe how to identify and manage information security risks, establish access controls and passwords, and ensure compliance with privacy laws and regulations.

Quality assurance policies

These policies outline the procedures for ensuring the quality and consistency of products or services. They describe how to identify and address potential quality issues, establish quality control measures, and maintain records and documentation.